National Vaccine
Information Center

Your Health. Your Family. Your Choice.

MedAlerts Home
Search Results

This is VAERS ID 36657

(NOTE: This result is from the 9/14/2017 version of the VAERS database)

Case Details

VAERS ID: 36657 (history)  
Form: Version 1.0  
Age: 14.0  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1991-11-18
Onset:1991-11-18
   Days after vaccination:0
Submitted: 1991-11-22
   Days after onset:4
Entered: 1991-11-26
   Days after submission:4
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 04161P / 1 RA / IM

Administered by: Private       Purchased by: Private
Symptoms: Apnoea, Cyanosis, Dyspnoea
SMQs:, Anaphylactic reaction (broad), Acute central respiratory depression (narrow), Pulmonary hypertension (broad), Cardiomyopathy (broad), Hypotonic-hyporesponsive episode (broad), Respiratory failure (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations: ~ ()~~~In patient
Other Medications: Slo bid, Ventolin, pred, allergy inject, vit B6, Beconase;
Current Illness: NONE
Preexisting Conditions: environmental allergies, asthma
Allergies:
Diagnostic Lab Data: NONE
CDC Split Type:

Write-up: minutes p/the inject pt was SOB progressing to cyanosis & respiratory arrest; mouth to mouth resucitation, epi given x 3, DPH & albuterol, 02;


New Search

Link To This Search Result:

https://www.medalerts.org/vaersdb/findfield.php?SNAPSHOT=20170914&IDNUMBER=36657


Copyright © 2020 National Vaccine Information Center. All rights reserved.
21525 Ridgetop Circle, Suite 100, Sterling, VA 20166